2007 Volume 16 Issue 6 Pages 751-757
Abdominal aortic aneurism (AAA) rupture is a disastrous condition with high mortality. This study was conducted to evaluate the factors influencing the operative outcomes. Two retrospective studies were performed. First, the proportion and outcome of AAA rupture among cases admitted to the emergency room of Saiseikai Fukuoka General Hospital, were reviewed from November 2003 to December 2005. Second, prognostic factors were compared between the survivors and deaths from AAA rupture during a 12-year period (1994 to 2005). From November 2003 to December 2005, 7327 cases were transferred to the emergency room of our hospital. Six cases of AAA rupture were included among 275 cases of cardio-pulmonary arrest on arrival (CPAOA). One of six cases was transfered to the operating room but died before aneurysmal repair. There were no survivors among the cases of CPAOA. From 1994 to 2005, 43 cases underwent surgery for ruptured AAA. Thirty cases (70%) survived and 13 (30%) died in our hospital. Preoperative cardio-pulmonary resuscitation, preoperative shock, suprarenal aortic clamp, massive blood loss were significantly associated with mortality. These factors reflected the seriousness of preoperative hypotension and the amount of retroperitoneal hematoma. Mortality as a function of time from onset of aortic rupture to hospital admission was 5/9 (56%) within 1 hour, 6/10 (60%) for 1 to 3 hours, 2/11 (18%) for 3 to 10 hours, 0/13 (0%) for more than 10 hours. Cases with a longer interval from onset of aortic rupture, seemed to be survivors with a stable condition. The incision-clamp times of the mortality cases were shorter than those of the survivors. Quick aortic clamping is essential for surgery for cases with severe hypotension. Mortality of ruptured AAA was significantly associated with preoperative circulatory insufficiency. Evaluation of the in-hospital emergency system and operative technique for aortic rupture should include admission-operation time, incision-clamp time, aortic clamping time in cases of preoperative shock as well as hospital mortality.
